Dyskinesia

Question 1

What are the four different types of tremor and what are some of the causes?

Answer 1

rest tremor: abolished on voluntary movement. Causes: Parkinsonism (idiopathic, drugs, trauma/boxing, encephalopathy postflu, manganese or copper toxicity, HIV, Parkinson-plus syndromes)
Intention tremor: irregular, large-amplitude, worse at the end of purposeful acts such as finger-pointing. Causes: cerebellar damage eg MS, stroke.
Postural tremor: absent at rest, present on maintained posture and may persist on movement. Causes: benign essential tremor, thyrotoxicosis, anxiety, beta-agonists
Re-emergent tremor: postural tremor developing after a delay of approx 10 secs.

Question 2

what is chorea?

Answer 2

non-rhythmic, jerky, purposeless movements flitting from one place to another

Question 3

What are the causes of chorea?

Answer 3

Huntington’s disease, Sydenham’s chorea (choreoathetoid movements as a rare complication of strep infection)

Question 4

What is hemiballismus?

Answer 4

large-amplitude, flinging hemichorea (affects proximal muscles) contralateral to a vascular lesion of the subthalmic nucleus. Recovers spontaneously over months

Question 5

What is athetosis?

Answer 5

slow sinuous, confluent, purposeless movements (esp digits, hands, face, tongue), often difficult to distinguish from chorea

Question 6

What are the causes of athetosis?

Answer 6

commonest is cerebral palsy

Question 7

What are tics?

Answer 7

brief, repeated, stereotyped movements which patients may suppress for a while. Common in children

Question 8

What is myoclonus?

Answer 8

sudden involuntary focal or general jerks arising from cord, brainstem or cerebral cortex

Question 9

What are some of the causes of myoclonus?

Answer 9

metabolic problems, neurodegenerative disease (lysosomal storage enzyme defects), CJD, benign essential myoclonus and myoclonic epilepsies

Question 10

What are the metabolic causes of myoclonus and what is the clinical sign typically seen?

Answer 10

asterixis (metabolic flap) - jerking of outstretched hands worse with extended wrists
Causes: liver or kidney failure, low sodium, increased CO2, gabapentin, thalamic stroke

Question 11

What are the tardive syndromes?

Answer 11

tardive dyskinesia - orobuccolingual, truncal, or choreiform movements
tardive dystonia - sustained, stereotyped muscle spasms of a twisting or turning character (retrocollis and back arching/opisthotonic posturing)
Tardive akasthesia - unpleasant inner sense of restlessness or unease +/- repetitive, purposeless movements
Tardive myoclonus
tardive tourettism
Tardive tremor

Question 12

What are the signs of acute dystonia?

Answer 12

torticollis (head pulled back)
trismus - oromandibular spasm
oculogyric crisis